FA03.01: LONG-TERM OUTCOMES OF PATIENTS WITH RECURRENT SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS UNDERGOING SALVAGE ENDOSCOPIC RESECTION

Abstract

Abstract Background introduction: Definitive chemoradiotherapy (dCRT) is a treatment option for esophageal squamous cell carcinoma (ESCC). Salvage endoscopic resection (ER) has a potential of cure for patients with local recurrence or residual tumor after dCRT, which is less invasive compared with salvage esophagectomy. Aim: To evaluate the long-term outcomes of patients with recurrence ESCC undergoing salvage ER and to identify risk factors associated with disease recurrence after salvage ER. Methods Retrospective analysis of 42 patients with ESCC treated with salvage ER for either local failure or recurrent disease after dCRT between January 2000 and December 2017. Salvage ER was indicated for clinically diagnosed T1N0M0 post dCRT in our hospital. Cox hazard model analysis was used to identify risk factors for recurrence after post-salvage ER. Results A total of 42 patients (35 males, 5 females), mean age 65 years (39–85), TNM stage before dCRT (I, II, III) 22/13/6, complete response (35 [85%]) were evaluated. The median time to salvage ER from the initiation of dCRT was 18.3months (2–130). ESD, EMR-C, and SB were performed for 4, 26, 11 patients. En-bloc resection rates were 100% (4/4), 61% (16/26) and 18% (2/11) for ESD, EMR-C, SB, respectively. There were no severe adverse event. Histological findings in the ER specimen was as follows; depth of invasion: T1a/T1b = 27/14(65/35%), lymphovascular invasion +/− = 7/34 (17/83%), vertical margin: 0/1/X = 34/4/3, and horizontal margin: 0/1/X = 25/5/11. A total of 19 patients (46%) developed recurrence after salvage ER. Recurrence sites were local/lymph node/local + lymph node/lymph nodes + distant metastasis in 9/8/2. For recurrent disease after ER, esophagectomy, lymphadenectomy and chemotherapy and best supportive care were performed for 8, 2, 4, 4 and 2, respectively, resulting in 6 death from ESCC. Three-year recurrence free survival rate, overall survival rate, and disease specific survival rate were 53.9%, 84.2%, and 88.4%, respectively. Multivariate analysis revealed that lymphovascular invasion was independent predictor of disease recurrence after salvage ER (HR = 2.96, 95%C. I 1.05–8.38, P = 0.04). Conclusion Salvage ER is clinically safe and effective in patients with local recurrence of ESCC after dCRT. Careful follow-up might be recommended for the patients with lymphovascular invasion. Disclosure All authors have declared no conflicts of interest.